Risk factors for dry sockets. - Part II.
This page discusses the following causes and risk factors for dry sockets (alveolar osteitis):
1) Smoking.
2) Oral contraceptives.
3) Oral bacteria.
4) Patient age.
5) Tooth location.
Part I of this topic explains patient history, extraction difficulty and failure to follow post-op instructions as risk factors.
A) Smoking.
Some studies have shown that people who smoke are more than four times as likely to develop a dry socket as compared to those who don't.
What's the cause?
A number of theories have been put forward as an explanation as to why this may be. Some of them are:
- The carbon monoxide that enters a person's bloodstream when they smoke limits the amount of oxygen that can be carried to, and therefore is available for, their extraction site's healing tissues.
- The sucking action created when a person smokes may dislodge or otherwise disrupt the blood clot that has formed in their tooth's socket.
- Nicotine may create systemic effects that interfere with the normal healing process.
- At a local level, tobacco smoke may damage or be toxic to tissue cells.
What precautions should you take if you do smoke?
As difficult as it may be, if you're a smoker you may be able to lessen your chances for a dry socket by not smoking on the day of your surgery and then for as many days afterward as possible. (Symptoms of dry socket formation typically appear within 5 to 6 days after an extraction.)
B) Oral contraceptives.
Women who take birth control pills may be at greater risk for experiencing dry sockets.
This factor, however, may have been a bigger issue in previous decades when oral contraceptives contained a larger dosing of estrogen.
What's the cause?
- The correlation between oral contraceptives and dry sockets may be due to fibrinolysis activity triggered by estrogen (this process leads to blood clot disintegration).
Oral contraceptive use may explain why women as a group are 20% more likely to experience dry sockets than men.
Planning the timing of your extraction can help.
Women who take birth control pills may be able to lessen their risks by scheduling their tooth extraction during those days when the estrogen dosing of their contraceptive regimen is at its lowest.
Ask your dentist for specific details. With some products, this will be those days (days 23 to 28 of your tablet cycle) when no pill, or else a placebo pill, is taken.
C) Oral bacteria.
Some dental research supports a view that bacteria play a role in the formation of dry sockets.
According to this theory, having one or more of the following conditions may place a patient at greater risk.
- A high bacterial count in the region of the extraction site (existing either before or after the extraction).
- An active infection in the gum tissue surrounding the tooth before it's extracted. (A condition termed pericoronitis.)
- A habit of practicing poor oral hygiene.
Additionally, some studies have suggested that the following steps can be used to help to prevent dry sockets:
- Having the patient rinse with an antibacterial mouthwash (chlorhexidine) before their tooth extraction.
- Placing an antibiotic-impregnated packing into the tooth socket immediately following an extraction.
Dry sockets are not usually treated with antibiotics.
Despite whatever role oral bacteria may play in their initial formation, most protocols for treating dry sockets do not include the use of antibiotics.
D) Patient age.
Some research suggests that there is a correlation between the age of a dental patient and their potential for developing a dry socket. As a general rule, comparatively younger patients are generally considered to be at less risk than comparative older patients.
How evident is this correlation?
One study found that dental patients in the age group 15 to 19 years developed dry sockets at a rate of about 3% whereas patients in the age group 30 to 34 experienced them at 3 times this rate. (This is one reason why a dentist might suggest to a patient that they should have their wisdom teeth removed during their late teens or early 20's.)
E) Tooth location.
The location of the tooth being extracted appears to correlate with a patient's risk for developing a dry socket.
In regards to location, here's what you can expect.
- There's generally a higher incidence of dry socket formation when a lower tooth is extracted, as opposed to an upper one.
- Having a posterior tooth pulled (especially a molar) typically poses a greater risk than a front tooth.
- The greatest risk appears to be associated with having a lower wisdom tooth, especially an impacted one, removed. (The situation shown in the picture to the right.)
